National Strategic Action Plan for Arthritis - Arthritis Australia
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National Strategic
Action Plan for
Arthritis
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 1© Commonwealth of Australia as represented by the Department Attribution
of Health 2019
Title: The National Strategic Action Plan for Arthritis Without limiting your obligations under the Licence, the
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Development of the National Strategic Action Plan for Arthritis 2019 was led by
Arthritis Australia with funding from the Australian Government Department of Health.
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 2CONTENTS
Acknowledgements 4
Foreword 5
Overview 6
About this Action Plan 9
What is Arthritis? 10
The Challenge of Arthritis 11
Living with Arthritis 13
Priority Areas 14
Priority 1 - Awareness, Prevention and Education 14
Priority 2 - High-value, Person-centred Care and Support 19
Priority 3 - Research, Evidence and Data 31
Achieving Progress 35
References 37
Appendix 1: Steering Committee Members 39
Appendix 2: A-Z of Arthritis 40
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 3ACKNOWLEDGEMENTS
Arthritis Australia would like to thank the many organisations
and individuals who have supported and provided
input to the development of this Action Plan.
In particular we would like to thank the following:
The members of the Steering Committee who provided their valuable time and expertise to help
shape the Action Plan.
The project team for the National Osteoarthritis Strategy, including members of the Leadership Group and
Working Groups, who shared their research, deliberations and recommendations with Arthritis Australia
to help inform the development of this Action Plan.
Participants in the Arthritis Roundtable held in December 2017 who identified potential actions and priorities
for consideration as part of the development of the Action Plan.
Members of the National Arthritis Consumer Reference Group who shared their experience of living
with arthritis and their ideas for improving arthritis care and support.
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 4FOREWORD
I am very pleased to have been asked to write the foreword for the National Strategic
Action Plan for Arthritis. This important initiative provides a comprehensive guide to
improving care and support for the four million Australians of all ages living with arthritis.
Arthritis can be an invisible disease and its true impact on people’s lives is poorly
understood. I experienced this firsthand when my daughter, Kate, was diagnosed with
juvenile arthritis in the early 1980s, when she was just 14 years old.
Through my involvement in the arthritis cause, many people have told me of their
struggles to cope with the pain, fatigue and life-changing impact of their arthritis, often
with little understanding from those around them of just what they were going through.
I have been inspired by their fierce courage and determination to live as normal a life as
possible with this painful and often debilitating condition. They should not have to do
this alone.
Implementing the recommendations detailed in this Action Plan will go a long way
towards improving arthritis awareness and education, reducing delays in diagnosis
and ensuring people with arthritis get the treatment, care and support they need.
The ambitious and forward-looking investment in research proposed will be essential
to help find better ways to treat and, ultimately to cure, arthritis in its many forms.
I congratulate all those who have contributed to the development of the Action Plan
and strongly encourage all stakeholders to work together to support its implementation.
I sincerely hope that this Action Plan provides a turning point that will help ensure that
everyone facing the challenge of arthritis gets the care and support they need to live
the best possible life, in spite of their condition.
Ita Buttrose AO, OBE
Emeritus Director
Arthritis Australia
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 5OVERVIEW
VISION : Freedom from the burden of arthritis.
PRIORITY AREAS
1 Awareness, prevention and education.
2 High-value, person-centred care and support.
3 Research, evidence and data.
These priority areas are interconnected and coordinated action will often be required
across two or more priority areas to maximise impact.
The National Strategic Action Plan for Arthritis provides Currently, there is a major mismatch between the
an evidence-informed blueprint to guide national burden of disease associated with arthritis and its
efforts to improve health-related quality of life for prioritisation in policy and resourcing which needs to
people living with arthritis, reduce the cost and be addressed. This Action Plan sets out priorities and
prevalence of the condition, and reduce the impact actions for addressing the challenge of arthritis with the
on individuals, their carers and the community. objective of achieving the best possible health and life
outcomes for people living with these painful and often
Arthritis is one of the most common, costly and
debilitating conditions. It aims to address issues
disabling of all chronic conditions. In its many forms
common to most forms of arthritis and has a strong
it affects nearly four million Australians of all ages,
focus on preventing the onset and progression of
including children and young people. Yet the personal,
arthritis, supporting people to become active
social and economic impact of arthritis is poorly
participants in their care and promoting person-
recognised and often wrongly trivialised.
centred, high-value treatment and care.
Misconceptions persist that arthritis is just a single
condition, that it only affects old people and is an The Action Plan identifies three key priority areas and
inevitable part of ageing about which nothing can be proposes a number of objectives and actions to
done. These misconceptions create a sense of futility achieve the overall vision of freedom from the burden
among consumers, health professionals and policy of arthritis. The priorities and actions of the Plan have
makers which undermines prevention, early diagnosis been developed with input from members of the
and effective management of the condition. Steering Committee (see Appendix 1), representing key
stakeholders in arthritis care; the project team
But much can be done to prevent and better manage
developing the National Osteoarthritis Strategy;
arthritis to reduce the severity of the condition and its
a range of targeted consultations with consumers,
impact on individuals, carers and families, health and
clinicians, policy makers and health service providers;
welfare systems, and the economy.
and a public consultation.
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 6OVERVIEW
PRIORITY AREAS
AND OBJECTIVES
Awareness, High-value Research,
prevention and person-centred evidence
education care and support and data
Increase community awareness Drive systems-level improvements to Fund a national arthritis and
and understanding of arthritis, its support the delivery of high-value care musculoskeletal health mission
risk factors and opportunities for for people with all types of arthritis. from the MRFF to increase
prevention and improved strategic investment in
management. Improve affordable and timely access to research and research
appropriate health care, services and capacity.
Reduce the risk of developing treatments.
arthritis across the life course. Enhance data collection,
Support health professionals with linkage and analysis to drive
Empower people with arthritis information, education and tools to quality improvement in arthritis
with information, education and deliver high-value arthritis care. prevention, management and
support to effectively self- outcomes.
manage their condition Address the needs of priority populations.
A range of detailed actions to support the achievement of
these objectives is outlined in the following pages.
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 7OVERVIEW
PARTNERSHIPS
Implementation of the actions included in this Action All partners have shared responsibility for health
Plan will require contributions by a wide range of outcomes according to their role and capacity within
partners. These partners include: the health care system. Greater cooperation between
Partners will lead to more successful individual and
● individuals, carers and families
system outcomes. Actions included in this Action Plan
● communities
are intended to guide Partner investment in the
● all levels of government
prevention and management of arthritis and should
● non-government organisations
be implemented collaboratively to achieve the best
● the public and private health sectors, including all
health outcomes.
health care providers and private health insurers
● industry
● researchers and academics.
OUTCOMES
Implementation of this Action Plan will improve The expected outcomes include:
prevention, management and support for people with
● Equitable, timely access to appropriate,
or at risk of arthritis. This will provide significant
comprehensive and person-centred health
benefits to individuals by reducing the pain and
services for people with arthritis
disability associated with arthritis, helping them to
● More effective use of limited health resources to
maintain their independence and quality of life and
deliver high-value services, with the potential for
maximising their ability to work and participate in social
significant cost savings in many areas
activities. Significant benefits will also accrue to the
● Reduced incidence and burden of disease
health system, society and the economy from better
● Improved health outcomes and quality of life
management of these highly prevalent and disabling
● Reduced disability and welfare expenditure
conditions.
● Reduced social and economic burden through
higher rates of social and workforce participation
for people with arthritis.
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 8ABOUT THIS
ACTION
PLAN
The National Strategic Action Plan for
Arthritis addresses the pressing need
for a coordinated and strategic national
response to the challenge of arthritis.
The intended audiences for the Action Plan include the The development of the Action Plan was led by Arthritis
Australian and state and territory governments, health Australia with the valuable input of an expert,
service providers and funders, clinicians, consumers, multidisciplinary Steering Committee, comprising
researchers and research funders. Implementation will representatives of major stakeholder groups with an interest
require national action and partnerships across all sectors in arthritis prevention, management and care. Steering
and levels of the health system, non-government Committee members included consumers, health
organisations, the private sector, researchers and professionals, researchers, policy makers and service
academics, and individuals. providers. Major contributions were also provided by the
project team for the National Osteoarthritis Strategy (2018),
The Action Plan builds on the recommendations of the Time
participants in the Arthritis Roundtable Workshop held in
to Move: Arthritis strategy which was published by Arthritis
December 2017, and the National Arthritis Consumer
Australia in 2014. It also closely aligns with and supports the
Reference Group.
goals, principles and strategic priority areas of the National
Strategic Framework for Chronic Conditions through a Targeted consultations with consumers, health professionals,
shared emphasis on prevention and efficient, effective and policy makers and service providers and a public consultation,
appropriate person-centred care to optimise quality of life for also informed the development of the Action Plan. Information
people with chronic conditions. The Action Plan also builds on these consultations, a summary of evidence supporting the
on and aligns with a range of other national and state-wide Action Plan and an outline of major arthritis-related initiatives
strategies, action plans and models of care, including the across Australia are provided separately.
National Strategic Action Plan for Pain Management
The development of this Action Plan has recognised the
(in preparation).
current fiscally constrained environment and so should guide
In particular, the Action Plan aligns with the National the Australian Government and state and territory
Osteoarthritis Strategy (2018) which has informed the governments in planning and directing funding in a cost-
development of many of the Plan’s recommendations. effective and sustainable way to improve the health of all
The Strategy provides additional detail regarding the Australians – specifically, to reduce the incidence and impact
implementation of recommendations relating to the of arthritis. Governments will use the activities in this Plan to
prevention and management of osteoarthritis. inform their prioritisation of effort. Action will vary in each
jurisdiction depending on available resources, current
programs and local needs.
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 9WHAT IS
ARTHRITIS
Arthritis is an umbrella term
for more than 100 conditions
affecting the joints and
surrounding structures.
These conditions damage the joints, causing swelling, pain, The second most common form of arthritis is rheumatoid
stiffness, reduced mobility and impaired physical function. arthritis, an inflammatory form of arthritis in which the
Some forms may also affect the heart, eyes, lungs, kidneys immune system attacks the joints and other parts of the
and skin and are associated with reduced longevity. Many body. Other forms of inflammatory arthritis include gout,
types of arthritis can progress over time, with worsening ankylosing spondylitis and psoriatic arthritis. Most forms of
symptoms and joint damage if not managed effectively. inflammatory arthritis are auto-immune conditions.
There is no cure for arthritis, although effective treatment Inflammatory forms of arthritis can affect people at any age,
and management can help to ease symptoms, achieve including children. Early diagnosis and intervention are
remission in some forms of arthritis, and slow or prevent crucial for most of these forms of arthritis. In rheumatoid
disease progression. arthritis for example, early diagnosis and treatment with
disease-modifying anti-rheumatic drugs, ideally within 12
The most common form of arthritis is osteoarthritis.
weeks of symptom onset, can prevent or delay joint
Osteoarthritis is often described as ‘wear and tear’, but this
damage, increase the chance of achieving disease
is not an accurate description of the disease. The joints do
remission and improve long-term outcomes, including
not wear away because of too much use. Osteoarthritis is
reduced disability.1
now understood to be the result of a breakdown in the
body’s normal joint repair processes. Osteoarthritis is more Juvenile Idiopathic Arthritis (JIA) is the most common
common in older age, but it can affect younger people, rheumatic condition in children. If not treated quickly and
especially those with a prior joint injury. Treatment options appropriately, it can seriously affect the growth and
include exercise, weight loss if required, and self- development of a child, causing severe joint damage,
management education as first-line therapies, with growth abnormalities and permanent disability. Although
pharmacological therapies useful as an adjunct for some. JIA resolves in many children, 50% of those diagnosed will
Joint replacement surgery may be appropriate for some continue to have active disease into adulthood.
people when other treatments are no longer effective.
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 10THE CHALLENGE OF
ARTHRITIS
Arthritis is one of the most common, ● Health system expenditure for arthritis was $5.5 billion in
costly and disabling chronic 2015, making arthritis one of the most expensive disease
groups in Australia.8
conditions in Australia and is the
leading cause of chronic pain. ● Two million Australians have osteoarthritis and nearly half a
million have rheumatoid arthritis.8
In its many forms arthritis affects nearly four million
● Hip and knee replacements for osteoarthritis cost the
Australians of all ages, including at least 6000
health system around $2.3 billion in 2012/13 and this is
children and two million people of working age (15-
projected to rise to $5.3 billion by 2030.10
64 years). The number of Australians with arthritis
is projected to rise to 5.4 million by 2030.3 ● Arthritis and musculoskeletal conditions account for 12% of
Arthritis can have a profound impact on a person’s quality of the total Australian disease burden, equal to mental health
life and well-being. The persistent pain and impaired mobility conditions. Arthritis alone accounts for around 8% of the
and physical function associated with arthritis can lead to total burden.11
problems with sleep, fatigue, depression and anxiety. It can
● Arthritis is the second most common cause of disability
also reduce a person’s capacity to study, work and participate
after back pain.12
in family and social activities. Children affected by JIA, even if
the condition resolves, often experience lifetime impacts ● Arthritis has a major impact on a person’s capacity to work
from the disease or its treatment, including poorer physical and is the second most common reason for early retirement
health and wellbeing, and lower educational attainment and due to ill health.13 In 2015, it cost over $1.1 billion a year in
employment prospects.4 extra welfare payments and lost taxation revenue, as well
as $7.2 billion in lost GDP.14 Arthritis also accounts for nearly
Arthritis also increases the risk of developing other chronic
half (40%) of the loss in full-time employment and 42% of the
conditions, and subsequently complicates their management,
loss in part-time employment due to chronic disease.15
due to its treatment (e.g. with non-steroidal anti-inflammatory
drugs or corticosteroids) and impact on mobility and systemic ● One in four people with arthritis experiences mental health
inflammation.5 This is a major issue as three out of four people issues.16 People with mental health conditions are also
with arthritis have at least one other chronic condition. In around 50% more likely to have arthritis than the general
addition, 52% of people with COPD, 41% of people with population.17
diabetes and 41% of people with cardiovascular disease report
that they also have arthritis.6 A strong relationship also exists ● By 2030, the number of people with arthritis is projected to
between arthritis and musculoskeletal pain and a lack of rise to 5.4 million and the associated health system cost to
physical activity, which can lead to functional decline, frailty, $7.6 billion.8
loss of independence and social isolation.7 Arthritis tends to be poorly managed in Australia.18 Much
Arthritis affects not only individuals living with the condition money is spent on low-value, ineffective or potentially harmful
but also their carers, family members, friends, local support care, at great expense to both governments and individuals,
networks, employers and communities. while proven, effective care strategies go unfunded.19 In
addition there is variable access to and delivery of services
Despite these impacts, the immense personal, social and and programs for children and adults with arthritis in both the
economic costs of arthritis are poorly recognised. These public and the private sector across Australia.20
costs include health care costs, personal and societal costs
associated with lost productivity due to the impact of arthritis There is a major mismatch between the burden and cost
on a person’s capacity to work, and, of course, the associated with arthritis and its prioritisation in policy and
immeasurable cost of lost wellbeing. Key indicators of the resourcing. Given the projected increase in arthritis prevalence
cost of arthritis include: and cost, there is an urgent need to implement policies and
programs to prevent arthritis and improve its management to
deliver high-value care, better outcomes and increased
health-related quality of life.
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 11ARTHRITIS IS ONE OF THE MOST COMMON,
COSTLY AND DISABLING CHRONIC CONDITIONS
4 MILLION HEALTH
AUSTRALIANS SYSTEM COST
LIVE WITH ARTHRITIS
$7.6
BILLION
$5.5
BILLION
THIS WILL RISE TO
5.4 MILLION
BY 2030 2015 2030
BURDEN
Proportion (%) of total, fatal and non-fatal burden by disease group, Australia 2011
0% 100%
Total 19% 15% 12% 12% 9%
Non-Fatal 24% 23% 12% 7% 6%
Fatal 34% 23% 14% 6% 5%
Cancer Cardiovascular Mental Arthritis & Injury Respiratory Neurological Other
Musculoskeletal
DISABILITY WORKFORCE IMPACT
Other
Back problems Asthma Back
problems
Diabetes 12%
16%
2% 23%
Cancer 4%
5%
15% Arthritis Diseases of
54% 6%
nervous sytems
6% 18%
6%
3% Injury/accident
7%
3% Hearing loss 10%
7%
3%
Lower limb injury Depression
Depression/mood Cardiovascular
Other conditions Asthma Mental health Arthritis
Proportion of all disability by main Main chronic conditions of people aged 45-64
disabling condition, Australia 2009 years not in the labour force due to ill health, 2010
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 12IN THEIR OWN WORDS LIVING WITH
ARTHRITIS
‘Sometimes, the pain feels like a truck is driving over you. ‘I have suffered since I was a teenager. If I don’t move I will
I tell myself I am not going to die from rheumatoid arthritis stiffen up. If I move I am in pain. Every day my body hurts.’
and often that’s the only thing that keeps me going.’
‘I have lost a lot of friends due to my diagnosis. I was unable
to attend many events due to chronic fatigue, pain and
‘No one seems to care. I received my diagnosis and was difficulty when driving due to high inflammatory levels.
told there was nothing they could do, take Panadol for I don’t think a lot of people realise exactly what I am
pain and see you later.’ suffering as I look “normal” on the outside.
‘My husband is going into enormous debt to renovate our
‘I am 32. Due to my condition, I can only work part time. home so I can move around easier, get into the shower,
I am limited by my pain and my medical appointments and go to the toilet, and even, with lower benches and oven,
tests. I struggle to stand, sit or walk for any length of time, cook again.
am in constant pain. My physical pain I can cope with,
Psychologically it is terrible as my self-worth has dwindled
but the shame and isolation from my financial hardship
and depression set in quickly. I had goals to finish my MBA,
is debilitating.’
now my goal is to get out of bed each day.’
‘I would have liked some emotional guidance at diagnosis.
‘Rheumatoid arthritis is killing me, slowly. It is taking the
I felt very alone despite my caring husband.
life I knew and changing the life we had planned for our
children. The physical pain I endure to just get up in the I was in a very ‘dark place’ for the first time in my life
morning is nothing anyone should experience. and quite frankly, I was scared.’
But I ask you; how do I explain to my children that it can’t
be cured? The mum my son remembers running around ‘Diagnosed with osteoarthritis at 22 years. I would love to
the park with him, is gone? ‘ have one night’s peaceful sleep with no pain…. just one
night. I would love to be able to walk without grinding my
teeth to hide my pain rather than let it show on my face.’
‘Last financial year I spent over $6,500 on medication
alone!!! This doesn’t take into account the many doctor ‘My 8 year old daughter was diagnosed with juvenile arthritis
visits, physiotherapy, podiatry and specialised exercise at 2 years of age. Regular visits to [hospital] for drug infusions
programs that I require.’ are essential in controlling her condition. It takes 90 minutes in
each direction to get to and from regular treatments [because]
services are not available in our local region.
‘I am 24 and live with rheumatoid arthritis. Some days the We as a family try to keep our heads above water with
pain and fatigue are so bad I can’t get dressed or cook regular illness due to her immunosuppression caused by the
myself a meal. Even on a good day I struggle with most treatment, time away from work, my child’s time away from
things ‘normal’ people don’t think twice about doing, such school and we just survive. Other family and friends truly have
as accessing a shopping centre or going to university.’ no idea of the impact of our situation. Financially we struggle.
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 131. AWARENESS, PREVENTION
AND EDUCATION
PRIORITY
AREA 1
What we hope to achieve
Improved community, policy maker and health professional awareness and understanding
of arthritis, its risk factors and opportunities for prevention and better management.
Lower arthritis incidence and prevalence by reducing modifiable risk factors.
Provision of timely information, education and support to people with arthritis and their
families and carers, to assist them to become active participants in their health care
and to help them to self-manage their condition at all stages.
Why is this important?
Although arthritis is very common, it is not well wellbeing and an individual’s ability to cope with their
understood. Community misconceptions persist that condition. However, a recent survey found that only
arthritis is a single condition that only affects old people around half of people receiving care for their arthritis
and that it is an inevitable part of ageing about which were satisfied with the information and support they
nothing can be done. These misconceptions create a received for their condition and only 30% were satisfied
sense of futility among consumers, carers and health with the support they received for their emotional and
professionals which can undermine prevention, early mental wellbeing.22 People who report poor access to
diagnosis and effective management.21 information and support are also more likely to report
that they are faring badly with their arthritis.23
There is also limited community awareness of modifiable
risk factors for arthritis including obesity, physical Education, information and support are required at all
inactivity, poor diet, smoking and joint injuries. Arthritis is stages of a person’s journey, but particularly at diagnosis
rarely included in public health messaging or policy and during a disease flare to assist people to understand
around chronic disease prevention or healthy lifestyle and actively manage their condition. People should
promotion. In addition, there is limited awareness that receive information and education about: their condition
sports injuries associated with increased osteoarthritis and treatments; likely prognosis/course of symptoms;
risk can be reduced by implementing simple, low cost medications; pain and pain management strategies;
sports injury prevention programs and timely and effective self-care strategies such as physical activity,
effective post-injury rehabilitation. healthy eating and weight loss where indicated; and
advice on reputable sources of evidence-based
Access to information, education and support from
information. Education and support needs to be tailored
health professionals and other sources is important to
to an individual’s needs which will vary depending on
equip people with chronic conditions such as arthritis
the type of arthritis they have, their age at diagnosis,
with the knowledge and skills to self-manage their
their personal life stage, their comorbidities, and the
condition and to participate in decisions about their
severity and duration of their condition.
care. It is also an important contributor to psychological
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 14RECOMMENDED ACTIONS PRIORITY
AREA 1
Increase community awareness
Objective 1.1 and understanding of arthritis, its
risk factors and opportunities for
prevention and improved management.
Actions Implementation
1.1.1 Priority topic areas and target audiences for awareness campaigns include:
● The importance of early diagnosis and treatment of inflammatory arthritis. Targets: general
Develop and deliver public, health professionals, PHNs.
education and
awareness campaigns ● The benefits of physical activity, smoking cessation, exercise and weight loss for managing
tailored to different
arthritis. Targets: people with or at risk of arthritis, health professionals.
target audiences, to
address identified
● Arthritis risk factors and prevention including obesity, physical inactivity, smoking and joint
community knowledge
gaps. injuries. Targets: general public, policy makers, health professionals, PHNs, industry, healthy
lifestyle program providers, sporting organisations, schools, sports participants, especially
adolescents and young adults and the fitness industry.
● Myth busting – countering common myths about arthritis (e.g. that it only affects old people).
Targets: general public, health professionals, policy makers.
Develop and deliver campaigns in partnership with consumers and other organisations where
appropriate, such as chronic disease groups and relevant health professional associations.
Include tailored, culturally-appropriate components for specific populations, developed in
collaboration with representatives of the target audience/s, including Aboriginal and Torres
Strait Islander peoples and culturally and linguistically diverse groups.
1.1.2 Update existing or new chronic disease prevention and management policies, programs and
funding arrangements across all levels of government to explicitly include a focus on arthritis.
Integrate arthritis into Include arthritis messaging in government-run campaigns and programs promoting physical
all appropriate health activity, healthy diets, weight management and smoking cessation.
care policies, programs
and reform initiatives
across all levels of
government in
Australia.
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 15RECOMMENDED ACTIONS PRIORITY
AREA 1
Reduce the risk of
Objective 1.2 developing arthritis
across the life course
Actions Implementation
1.2.1 Engage with government and organisations active in obesity prevention to raise
awareness of the link between obesity and arthritis.
Raise awareness of Partner with organisations promoting sport and physical activity to advocate for policies,
modifiable risk factors
programs and infrastructure to encourage safe, increased physical activity at every age.
for arthritis.
Include a warning message about smoking increasing the risk of developing rheumatoid
arthritis as one of the health warnings on tobacco products.
1.2.2 Work with government, community and industry to promote the implementation of the
Tipping the Scales: Australian obesity prevention consensus recommendations and
other obesity prevention policies and programs.
Work with government
and other stakeholders to
support the development
and implementation of the
national obesity strategy.
1.2.3 Develop and implement a national sports injury prevention program in collaboration with
Sport Australia, injury prevention researchers, sport and exercise health professionals,
sporting bodies and organisations, schools and the fitness industry.
Develop and implement a
national sports injury Require government-supported sporting programs such as Sporting Schools to implement
prevention program to
reduce sports injuries sports injury prevention programs as a condition of funding.
associated with increased
arthritis risk.
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 16RECOMMENDED ACTIONS PRIORITY
AREA 1
Empower people with arthritis
Objective 1.3 with information, education and
support to effectively self-manage
their condition.
Actions Implementation
1.3.1 Fund community-based arthritis educators to deliver targeted national information,
education and support programs for children and adults with arthritis.
Fund arthritis educators Fund arthritis educators within the public and private health systems to integrate the
to provide education
provision of patient-centred education, support and care co-ordination into health
and support to children
and adults with arthritis. service delivery.
Educators need to be appropriately skilled and could be drawn or upskilled from a range
of disciplines including nursing (rheumatology and/or practice nurses), allied health and
pharmacy, with levels of practice determined by skills and competencies (see 2.3.2).
1.3.2 Contribute funding to develop, implement and evaluate an innovative comprehensive,
digitally-enabled patient support program for people with inflammatory arthritis.
Expand existing and Develop and trial arthritis-appropriate telephone coaching programs, for national roll-out.
develop new Programs should incorporate behavioural change strategies and should be developed and
information, education
and support programs to evaluated for different types of arthritis including osteoarthritis, inflammatory arthritis
assist people with (including JIA) and gout.
arthritis to proactively
manage their condition. Expand the reach and coverage of JIA kids camps and programs run by arthritis
organisations to cater for more children, different age groups including young adults, and
children with other rheumatic conditions.
Expand peer support programs for people with arthritis to cater for groups with different
needs, including children and their families
Expand and enhance the existing Arthritis Infoline support service to provide a more
comprehensive, nationally consistent service, supported by healthcare professionals (e.g.
nurses, allied health professionals) with knowledge of locally available services.
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 17RECOMMENDED ACTIONS PRIORITY
AREA 1
Empower people with arthritis
Objective 1.3 with information, education and
support to effectively self-manage
their condition.
Actions Implementation
1.3.3 Develop comprehensive new health promotion resources with a focus on exercise to support
people with arthritis and health professionals to use exercise and physical activity to help
manage arthritis.
Develop and
disseminate new
Expand existing and develop new resources for Aboriginal and Torres Strait Islander peoples
consumer information,
tools and resources to and culturally and linguistically diverse groups, including video tutorials in different languages.
address identified gaps Develop and promote these resources in partnership with representative stakeholder groups.
and unmet needs.
Develop age- and developmentally-appropriate resources and programs to support children
and young people and their families living with JIA. These should include resources suitable for
preschool, primary-school and high-school age children, resources and programs for schools,
and transition resources to support children as they move to adulthood.
Develop information resources for less common types of arthritis and for people at different
ages, disease stages (e.g. at diagnosis, during a flare) and life stages, such as family planning.
Develop resources and programs to support people with arthritis in the workplace.
Maintain a central on-line repository of information, resources and education programs for
consumers and health professionals.
Care guides or standards should be based on the most up-to-date clinical practice
1.3.4
guidelines which include diagnosis, comprehensive assessment and care planning, disease
education and self-management strategies, pain management, medication, early treatment,
Develop and management of established disease and surgery. The consumer fact sheet for the
disseminate consumer-
focused guides or Australian Commission on Safety and Quality in Health Care’s Osteoarthritis of the Knee
standards of care for Clinical Care Standard and the European Musculoskeletal Conditions Surveillance and
people with arthritis so Information Network’s (eumusc.net) consumer standards of care could be used as a guide.
they know what care
they should receive.
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 182. HIGH-VALUE,
PERSON-CENTRED
PRIORITY
CARE AND SUPPORT AREA 2
What we hope to achieve
Children and adults with arthritis receive holistic, comprehensive, and person-centred care
that is culturally appropriate and tailored to their individual needs and circumstances.
Children and adults with arthritis have equitable, affordable and timely access to appropriate
care in line with their needs, including lifestyle interventions, specialist and interdisciplinary
team care delivered by appropriately-skilled health professionals, pain management
services, psychological support services and surgery if required.
Evidence-based models of care for arthritis and pain management are implemented across
Australia to deliver nationally consistent, high-value care and support.
Health services are adequately resourced and structured to support rapid access to
affordable specialist care for those who need it.
Health professionals are skilled and supported with information, education and tools to
deliver high-value arthritis care.
Priority populations, including Aboriginal and Torres Strait Islander peoples, receive
equitable access to information, health services and support that is timely and culturally
appropriate.
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 192. HIGH-VALUE,
PERSON-CENTRED
PRIORITY
CARE AND SUPPORT AREA 2
Why is this important?
Evidence indicates that much needs to be done The delivery of appropriate evidence-based care can
to improve the current management of arthritis in be facilitated by developing and implementing models
Australia,24 with two thirds of people with arthritis of care. Models of care are evidence- and consultation-
reporting that they are faring badly with their based frameworks that describe what and how health
condition.25 The most common problems reported by services and other resources should be delivered to
people with arthritis are inadequate pain management, people with specific health conditions. They provide an
lack of information and support to help them to self- effective way to embed evidence into health policy and
manage their condition and the high costs of care. practice and achieve system efficiencies.37
Other reported problems include: delays in diagnosis
A number of arthritis-related models of care already
and treatment; limited and inequitable access to
exist in some jurisdictions and are at various stages of
services, especially public services; limited access to
implementation. These models have been developed
interdisciplinary care; fragmented, uncoordinated care;
by state-based musculoskeletal clinical networks.
and lack of psychosocial support.26 27
Where evaluations or reviews are available, these
Major evidence-practice gaps relating to the delivery of models of care have been shown to achieve system
arthritis care in Australia include: efficiency gains; to improve the quality of health care
delivered; and to improve community access to
● Inadequate, inappropriate management of
appropriate, timely care.38 39 An example is the New
osteoarthritis, with limited uptake of effective lifestyle
South Wales Osteoarthritis Chronic Care Program
interventions such as exercise and weight loss, and
(OACCP), which provides assessment and non-surgical
over-reliance on medications and surgery.28 29
management for people on the waiting list for joint
● Delays in diagnosis and access to specialist care for replacement surgery. Evaluation of the model found that
children and people with inflammatory arthritis, it improved clinical outcomes, facilitated earlier access
which is associated with poorer outcomes.30 31 to surgery where clinically indicated, and reduced
demand for surgery, with 11% of participants waiting for
● Limited access to interdisciplinary team care, which is
knee replacements and 4% awaiting hip replacements
consistently recommended in local and international
deciding they no longer required surgery.39
guidelines and standards of care for children and
adults with most forms of arthritis. There is scope to adapt and implement existing models
of care more broadly across the country, as well as to
● Poor utilisation of urate lowering therapy for gout.32
develop new models of care to address significant
● Lengthy waiting times for joint replacement surgery evidence-practice gaps. This process would be
in the public sector 33 and significant levels of patient facilitated by establishing appropriate clinical networks
dissatisfaction following surgery. 34 35 in those jurisdictions where they do not currently
operate. In addition, establishing a national network -
● Limited access to paediatric rheumatology services, a National Arthritis Collaboration - would support
including transition care programs for adolescents a strategic and coordinated approach to driving
and young adults moving from paediatric to adult improvements in prevention and care across the
services.36 country. This Collaboration could be expanded to
address musculoskeletal conditions more broadly,
to reflect the scope of existing jurisdictional networks.
A similar approach has been effective in driving a
whole-of-system approach to support the delivery
of improved musculoskeletal prevention and care
in England.40
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 20RECOMMENDED ACTIONS PRIORITY
AREA 2
Drive systems-level
Objective 2.1 improvements to support the
delivery of high-value care for
people with all types of arthritis.
Actions Implementation
2.1.1 The Collaboration would work inclusively with state- and territory based musculoskeletal
clinical networks and other stakeholder groups. Membership of the Collaboration would
include clinicians, researchers, consumers, policy makers and health service providers.
Establish and fund a
National Arthritis
Support the work of the Collaboration with adequate funding and resources.
Collaboration to engage
with and align efforts The role of the Collaboration would be to:
across multiple
stakeholders, sectors and ● Galvanise and support partnerships across multiple sectors and levels of the health system
levels of the health system and other stakeholders to work collaboratively to reduce the burden of arthritis.
to drive improvements in
arthritis prevention and ● Develop and promote consistent, national standards of care.
management.
● Identify models of care and interventions suitable for national implementation, adapted to
suit local circumstances and resources (see 2.1.2).
● Define, prioritise and develop resources and projects, including a research agenda, to
support best-practice, high-value care.
Establish formal state and territory musculoskeletal clinical networks supported by local
departments of health where these do not already exist, to develop and implement models of
care and quality improvement initiatives.
2.1.2 Assess, adapt as required, and fund the implementation of existing evidence-based,
jurisdictional models of care relevant to arthritis across Australia, including:
Fund the implementation ● Victorian Model of Care for Osteoarthritis of the Hip and Knee
of evidence-based ● Osteoarthritis Chronic Care Program (OACCP) (New South Wales)
musculo-skeletal models
of care across Australia to ● Osteoarthritis Hip and Knee Service (Victoria)
guide the delivery of ● Local Musculoskeletal Service (delivers OACCP in a primary care setting) (New South Wales)
appropriate health ● Model of Care: New South Wales Paediatric Rheumatology Network
services for people with
arthritis. ● Elective Joint Replacement Service Model of Care (Western Australia)
● Inflammatory Arthritis Model of Care (Western Australia)
● Western Australian Framework for Persistent Pain 2016-2021
● Service model for community-based musculoskeletal health in Western Australia
● Musculoskeletal Triage and Assessment Service (Tasmania).
Identify areas of need and develop and implement new evidence-based models of care
to address them. This process could be driven by the National Arthritis Collaboration
recommended in 2.1.1.
Embed models of care in local information and care pathways such as HealthPathways.
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 21RECOMMENDED ACTIONS PRIORITY
AREA 2
Drive systems-level
Objective 2.1 improvements to support the
delivery of high-value care for
people with all types of arthritis.
Actions Implementation
2.1.3 Pilot and evaluate a community-based, interdisciplinary arthritis clinic to provide a one-stop
shop for diagnosis, assessment, triage, treatment and/or referral to other specialists and
services. The clinic could be hosted or run by a GP or specialist practice, an arthritis consumer
Trial and evaluate
innovative models for organisation, a community health centre, or in partnership with one or more Primary Health
delivering better care Networks (PHNs)/Local Hospital Districts (LHDs).
for people with arthritis
and to improve care In collaboration with LHDs, PHNs and researchers, trial models for delivering specialist and
coordination.
interdisciplinary care within a primary care setting, such as the Inala Clinic model or the West
Sydney Diabetes Alliance model. These models allow patients to access specialist care in
their usual place of care, upskilling local primary care team members and supporting
integrated patient-centred care.
Trial and evaluate the effectiveness of shared medical appointments in both primary and
secondary care to provide education and support for people with arthritis.
2.1.4 This funding could be used to:
● Commission services to address shortfalls in local services and programs for people
Provide dedicated with arthritis
funding to PHNs to
commission programs ● Develop locally tailored pathways of care for people with arthritis where these
to address the needs of
children and adults with
do not already exist (e.g. via HealthPathways).
arthritis in their area.
● Improve integration of care across primary, secondary and tertiary care services.
● Trial innovative models of care and funding options to support affordable and equitable
access to appropriate services.
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 22RECOMMENDED ACTIONS PRIORITY
AREA 2
Improve affordable and timely
Objective 2.2 access to appropriate health care,
services and treatments
Actions Implementation
2.2.1 Increase the rheumatology workforce (see 2.2.2) and adopt innovative care delivery models
and workforce strategies to reduce waiting times for rheumatology services. Strategies
include:
Drive early diagnosis
and intervention for
● Advanced practice physiotherapy clinics to assess, triage and manage general
children and adults
with inflammatory musculoskeletal patients on rheumatology wait lists.
arthritis.
● Appropriately-skilled rheumatology nurse specialists or nurse practitioners to triage
urgent cases and undertake less complex management tasks within their scope of
practice.
● Early arthritis clinics for people with suspected inflammatory arthritis.
Develop information and education materials, programs and tools for primary health care
professionals to promote early diagnosis and intervention for children and adults with
inflammatory arthritis (see 2.3.2 and 2.3.3).
Develop and deliver an awareness and education campaign to increase consumer and health
professional knowledge of inflammatory arthritis symptoms and the importance of early
diagnosis and rapid referral to specialist care (see 1.1.1)
2.2.2 Undertake a workforce assessment and planning exercise to review the current adult and
paediatric rheumatology workforce in both the public and private sector to identify priority
areas of unmet need.
Improve access to
affordable specialist
Expand funding for public adult and paediatric rheumatology services in identified areas of
adult and paediatric
rheumatology need across Australia to reduce waiting lists and improve equitable access to timely and
services. affordable specialist and interdisciplinary services.
Increase funding for rheumatology training positions especially in areas of identified
workforce shortfalls such as Queensland, Western Australia and rural areas.
Provide funding through the Specialist Training Program to support rheumatology training in
non-traditional settings such as non-tertiary hospitals and private practice.
Provide dedicated funding for paediatric rheumatology training, which is currently unfunded,
and expand public funding for paediatric rheumatology consultant, nurse and allied health
positions. In addition, fund appropriate transition care services for young people moving from
paediatric to adult rheumatology services.
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 23RECOMMENDED ACTIONS PRIORITY
AREA 2
Improve affordable and timely
Objective 2.2 access to appropriate health care,
services and treatments
Actions Implementation
2.2.3 Develop, trial and implement funding models (public and private) to better support
appropriate team-based care for people with arthritis.
Improve affordable Funding models should enhance affordable access to evidence-based interdisciplinary
access to
packages of care including patient education and support, exercise, healthy diet advice,
interdisciplinary team
care, including weight loss, pain management and psychological health interventions, tailored to an
appropriately-skilled individual’s needs and preferences.
nurses, allied health
professionals and Fund rheumatology nurses and/or allied health professionals to provide education, care and
relevant medical
support, including care coordination, for people with severe or inflammatory arthritis, in both
specialists.
the public and private sector:
● Trial and evaluate a rheumatology nurse service offered through arthritis organisations,
PHNs, LHDs or community health services for people being managed in private practice
(similar to the McGrath breast cancer nurse model).
● Extend the existing practice nurse MBS item numbers to specialist nurses working in
secondary care in the private sector.
Increase the number of allied health services available under MBS Chronic Disease
Management items. Based on the clinical judgement of the treating clinician, people with
arthritis who may benefit should be able to receive an additional five services per calendar year.
Provide MBS funding for group allied health services, including assessment and review, for
people with arthritis (as is currently available for people with type 2 diabetes).
Develop pathways and recognition processes for advanced practice nurses and allied health
professionals with particular expertise and experience in managing complex patients with
arthritis. This would assist health professionals and people with arthritis to identify
appropriately-skilled practitioners in their local community.
Ensure affordable access to other relevant physicians and specialists, such as pain specialists,
sports and exercise physicians, orthopaedic surgeons and rehabilitation physicians, as part of
the interdisciplinary team, in line with an individual’s needs.
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 24RECOMMENDED ACTIONS PRIORITY
AREA 2
Improve affordable and timely
Objective 2.2 access to appropriate health care,
services and treatments
Actions Implementation
2.2.4 Support health and non-health professionals with training and tools to recommend and
deliver tailored, evidence-based, non-pharmacological and non-surgical care and support
for people with arthritis (see 2.3).
Increase the uptake of
effective lifestyle and
Provide funding for people with arthritis to access arthritis-appropriate evidence-informed
self-management
interventions for people exercise programs, pain coping skills training and weight loss services.
with arthritis.
Upskill and accredit exercise professionals in the delivery of evidence-based, arthritis-
appropriate exercise programs, e.g. roll out The Joint Movement program in conjunction
with Arthritis Australia Affiliates.
Increase affordable access to exercise health professionals, such as specialist sport and
exercise physicians, physiotherapists and exercise physiologists, to enhance exercise
therapy for people with arthritis.
2.2.5 Ensure that people with osteoarthritis have had access to evidence-based, non-surgical
management, both in the community and in outpatient settings, before considering joint
replacement surgery or being placed on a joint replacement waiting list.
Improve equitable and
timely access to
Develop an optimal decision aid and educational materials to support informed decision-
appropriate surgical
care for people with making for joint replacement surgery for both health professionals and people with
arthritis. osteoarthritis and embed them into clinical practice.
Standardise and improve patient pathways from GP assessment through to rehabilitation
and follow-up, to improve patient outcomes and the timeliness and efficiency of surgical care
(e.g., as per the Western Australia Elective Joint Replacement Service Model of Care).
Upscale existing and implement new advanced scope physiotherapy-led clinics for
orthopaedic triage and standard post-surgical reviews.
Implement a consistent national post-operative pathway of care with an emphasis on
discharge to the home where access to appropriate post-operative care services suitable for
the patient are available.
Develop, trial and evaluate community- or home-delivered postoperative rehabilitation options.
Provide private health insurance funding for community or home-based rehabilitation
following joint replacement surgery.
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 25RECOMMENDED ACTIONS PRIORITY
AREA 2
Support health professionals
Objective 2.3 with information, education
and tools to deliver high-value
arthritis care.
Actions Implementation
2.3.1 Promote the uptake of the recently revised RACGP Guideline for the management of knee
and hip osteoarthritis as outlined in the communication, implementation and dissemination
plan that accompanies the Guideline.
Establish and promote
guidelines and systems
Develop and disseminate up-to-date standards of care suitable for primary health
to assist health
professionals to deliver professionals for best-practice diagnosis and early and ongoing management of
high-value clinical care inflammatory arthritis, based on the latest national and international recommendations.
for children and adults
with different types of Consider the development and production of ‘living’ guidelines for arthritis, using advanced
arthritis.
methodology to create recommendations tailored to the Australian practice context and
updated in real time as new evidence is produced.
Embed up-to-date information into clinical information systems and care pathways such as
HealthPathways.
NATIONAL STRATEGIC ACTION PLAN FOR ARTHRITIS 26You can also read
